“moschetoes Were Uncommonly Numerous”

Yellow fever killed 4,000 in Philadelphia in 1793, amd puzzled doctors ignored the real clue to blame “miasmata” in the air

Late in the evening of August 21, 1793. Dr. Benjamin Rush, Philadelphia’s most prominent physician, sat down “much fatigued” to write to his wife to inform her that a “malignant lever” had broken out on the city’s water front. The disease, which had carried off twelve persons, was “violent and of short duration.”

“It had,” he wrote, “in one case killed in twelve hours,” and in no case had it lasted more than four days. What he did not write was that he had become convinced that it was the dreaded yellow fever.

In the beginning of August Dr. Rush had been called to see the child of a colleague suffering from fever and jaundice. The child died. During the next two weeks Dr. Rush treated several other patients with similar symptoms, but not until August 19 did he suspect the true nature of the disease. Much distressed, he communicated his diagnosis to several colleagues and friends and shortly it became known throughout the city. He was disbelieved at first and even ridiculed by many, but the rapid spread and malignity ol the disease soon left no doubt that it was indeed yellow fever.

Even is now moved swiftly. On August 22 the mayor of Philadelphia, Matthew Clarkson, officially notified the city commissioners of the outbreak of a contagious fever in the city and issued stricl orders for the immediate removal and disposal of all filth from the streets.

On August 25 the College of Physicians held a special meeting to “confer upon the treatment of the existing malignant fever,” and recommendations lor preventing its further progress were adopted.

On August 29 the governor of the stale addressed the legislature on the situation in Philadelphia and reported on the measures taken in the emergency. He also ordered the mayor to enforce the recommendations of the College and to do everything “to prevent the extension of, and to destroy, the evil.”

Of all the infectious and contagious diseases, none of which was well understood at that time, yellow fever was one of the most deadly. Endemic at this period on the American mainland and the West Indies, it erupted from time to time without apparent rhyme or reason. During the last century there had been repeated major outbreaks in the Caribbean and on the mainland. In Philadelphia the last outbreak had been in 1762. It was the experience acquired as a young man during that epidemic that had let Dr. Rush recognize the prevailing lever tor what it was and had Riled him with trepidation.

Why had the fever now recurred? Had it originated in the city? Had it been brought in? Civic pride was involved and men’s answers to these questions, regarded almost as a measure of their loyalty to the community, became the source of bitter discord.

Since all of the early cases had occurred in persons living near the water front, it was logical to search there for the source of the epidemic. Dr. Rush soon believed he had found it in the “putrid exhalations” from some damaged coffee which had been dumped on a wharf near Water Street and left to rot. The official investigations of Dr. Hutchinson. the inspector of sickly vessels, supported this view which, placing the origin of the lever squarely in the city, was very unpopular with the majority of the citizenry.

General acclaim, however, was accorded another theory which traced the epidemic to the French privateer San Culottes (twelve guns and 100 men), described as a Olthy and unbelievably overcrowded ship. This vessel had brought her prize, the Flora (out of Glasgow), into Philadelphia toward the end of July and had docked with her also near Water Street. Some “highly respected citizens and gentlemen” later attested that they had seen a dead body, sewed up in canvas, lying on board the Flora , and also said that corpses had been secretly landed at night from the two ships. All of which pointed clearly to a foreign origin of the epidemic.

The disease was soon city-wide. It was violent and resisted all treatment and the rumor began to spread that it was in reality the plague. Frequently it set in abruptly, with a shaking chill and high lever, but more often its onset was insidious. It “stole on” with headache, languor, and an upset stomach. Vomiting, stupor, and delirium followed. The hands and feet were cold, the pulse feeble and slow. The eyes. at first bloodshot, later became yellow. On the third or lourth day the entire skin was yellow.

Livid spots now appeared on the body and there was bleeding from the nose, the gums, and the bowels. A black vomit often heralded the impending end. Many died on the second or third day; lew survived the fifth. “The common remedies for malignant fever have all failed,” wrote Dr. Rush. “Bark [quinine], wine, and blisters make no impression upon it.” Medical science was helpless.

The populace was panic-stricken. Whoever could do so left the city or made preparations to leave. All day long carts, wagons, and coaches rolled through the streets, taking whole families with their household goods into the country. Thousands upon thousands sought their salvation in flight from the doomed city.

The suddenness with which the lever had descended upon the city, the failure of the measures taken to prevent its propagation, the ineffectualness of medical treatment, all had an enervating effect upon those who remained. Nobody knew what to do or what not to do. In their fear and desperation people resorted to fantastic measures to stem the tide of the epidemic.